New Study Suggests Insurance Denials Could Be Making Patients Sicker

By Consumers for Quality Care, on August 25, 2017

A new study by the Doctors-Patient Rights Project (DPRP), found that over 50 million Americans are lacking access to health treatments, despite having insurance. Specifically, the study looked at insurance denials and their long-term effects on patients. According to the study, one third of patients who experienced insurance denials have had their health adversely effected as a result.

Health insurers denied coverage for nearly a quarter of the Americans with chronic conditions or persistent illnesses. In a third of the cases, these patients, all of whom had insurance coverage, said their conditions worsened after being rejected.

One possible cause, nearly 35% of patients denied coverage had to delay or forfeit their treatments.

When a patient is denied coverage, the insurer’s appeal process is often the next step. However, the study found that the appeals process does not always work either.

Less than half were successful in their appeals, and 50 percent of those denied were turned down multiple times.

Unfortunately for consumers, the severity of illness or need for treatment does not appear to decrease the likelihood of an appeal.

70% of the denied treatments for chronic or persistent illnesses were for conditions described as “serious,” and 43% were for treatment of patients described as “in poor health.”

The study’s findings, that even with insurance, those who need medical help often have troubles obtaining it, are troublesome to patients and advocates alike.

“Our research reveals a hidden healthcare crisis,” said Stacey Worthy, Executive Director of Aimed Alliance and one of DPRP’s founding members. “The current debate about healthcare reform has focused on getting more Americans covered. Yet, the real crisis is among patients with chronic illnesses who tell us that insurance is worthless when their insurance providers withhold coverage of essential treatments prescribed by a doctor.”